Provider Demographics
NPI:1588603559
Name:HUPPERT, LEONORE CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:LEONORE
Middle Name:CHARLES
Last Name:HUPPERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SPRUCE ST
Mailing Address - Street 2:ONE PINE EAST
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6130
Mailing Address - Country:US
Mailing Address - Phone:215-829-6385
Mailing Address - Fax:215-829-6553
Practice Address - Street 1:800 SPRUCE ST
Practice Address - Street 2:ONE PINE EAST
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6130
Practice Address - Country:US
Practice Address - Phone:215-829-6385
Practice Address - Fax:215-829-6553
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014281E207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0052744000OtherKEYSTONE HEALTH PLAN EAST
PA025681OtherPERSONAL CHOICE
PA025681OtherPERSONAL CHOICE
PA025671K2ZMedicare ID - Type Unspecified